Plan Materials and Forms

Information about plan benefits, services, and drug costs can be found in your plan materials.

Look at your Wellcare By Allwell member ID card for your plan number and type to view materials for your plan.

View a sample of an Wellcare By Allwell Member ID Card to see where this information is located.

You can also look for plan materials based on the plan name and the county you live in.

If you don’t have a Wellcare By Allwell ID card or have questions about plan materials, give us a call. We’re here to help.

This booklet gives you a summary of costs and coverage in your plan.

Please select the document for your plan and county:

For HMO D-SNP Members:

Plan Name	CMS#	County	Summary of Benefits
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 001	Duval, Volusia	Summary of Benefits H5190-001- English (PDF) Summary of Benefits H5190-001- Spanish (PDF)
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 002	Hillsborough, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole	Summary of Benefits H5190-002 - English (PDF) Summary of Benefits H5190-002 - Spanish (PDF)
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 003	Broward	Summary of Benefits H5190-003 - English (PDF) Summary of Benefits H5190-003 - Spanish (PDF)
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 004	Miami - Dade	Summary of Benefits H5190-004 - English (PDF) Summary of Benefits H5190-004 - Spanish (PDF)
Wellcare Dual Nurture (HMO D-SNP)	H5190 - 005	Broward, Duval, Hillsborough, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, Volusia	Summary of Benefits H5190-005 - English (PDF) Summary of Benefits H5190-005 - Spanish (PDF)
Wellcare Dual Nurture (HMO D-SNP)	H5190 - 006	Miami - Dade	Summary of Benefits H5190-006 - English (PDF) Summary of Benefits H5190-006 - Spanish (PDF)

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:

For HMO D-SNP Members:

Plan Name	CMS#	County	Evidence of Coverage
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 001	Duval \| Volusia	Evidence of Coverage H5190-001 - English (PDF) Evidence of Coverage H5190-001 - Spanish (PDF)
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 002	Hillsborough \| Orange \| Osceola \| Palm Beach \| Pasco \| Pinellas \| Polk \| Seminole	Evidence of Coverage H5190-002 - English (PDF) Evidence of Coverage H5190-002 - Spanish (PDF)
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 003	Broward	Evidence of Coverage H5190-003 - English (PDF) Evidence of Coverage H5190-003 - Spanish (PDF)
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 004	Miami - Dade	Evidence of Coverage H5190-004 - English (PDF) Evidence of Coverage H5190-004 - Spanish (PDF)
Wellcare Dual Nurture (HMO D-SNP)	H5190 - 005	Broward \| Duval \| Hillsborough \| Orange \| Osceola \| Palm Beach \| Pasco \| Pinellas \| Polk \| Seminole \| Volusia	Evidence of Coverage H5190-005 - English (PDF) Evidence of Coverage H5190-005 - Spanish (PDF)
Wellcare Dual Nurture (HMO D-SNP)	H5190 - 006	Miami - Dade	Evidence of Coverage H5190-006 - English (PDF) Evidence of Coverage H5190-006 - Spanish (PDF)

If you were enrolled in Wellcare By Allwell last year, this booklet will tell you about changes to your plan’s costs and benefits for the coming year.

Please select the document for your plan and county:

For HMO D-SNP Members:

Plan Name	CMS#	County	Annual Notice Of Changes
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 001	Baker \| Duval \| Hardee \| Hernando \| Lake \| Manatee \|Marion \| Martin \| Volusia	Annual Notice of Changes, H5190-001 - English (PDF) Annual Notice of Changes, H5190-001 - Spanish (PDF) - coming soon
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 002	Hillsborough \| Orange \| Osceola \| Palm Beach \| Pasco \| Pinellas \| Polk \| Seminole \| St.Lucie	Annual Notice of Changes, H5190-002 - English (PDF) Annual Notice of Changes, H5190-002 - Spanish (PDF)
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 003	Broward	Annual Notice of Changes, H5190-003 - English (PDF) Annual Notice of Changes, H5190-003 - Spanish (PDF)
Wellcare Dual Medicare (HMO D-SNP)	H5190 - 004	Miami - Dade	Annual Notice of Changes, H5190-004 - English (PDF) Annual Notice of Changes, H5190-004 - Spanish (PDF)
Wellcare Dual Nurture (HMO D-SNP)	H5190 - 005	Broward \| Duval \| Hillsborough \| Orange \| Osceola \| Palm Beach \| Pasco \| Pinellas \| Polk \| Seminole \| Volusia	Annual Notice of Changes, H5190-005 - English (PDF) Annual Notice of Changes, H5190-005 - Spanish (PDF)
Wellcare Dual Nurture (HMO D-SNP)	H5190 - 006	Miami - Dade	Annual Notice of Changes, H5190-006 - English (PDF) Annual Notice of Changes, H5190-006 - Spanish (PDF)

AHIP Flyer (PDF)

Plan Name	CMS#	County	Annual Notice of Change (ANOC)
Ascension Complete Florida Reward (HMO)	H8225 - 001	Baker, Clay, Duval, Escambia, Nassau, Santa Rosa, St. Johns, Walton	Annual Notice of Change H8225 - 001 - English (PDF) Annual Notice of Change H8225 - 001 - Spanish (PDF) - Coming Soon
Ascension Complete St. Vincent's Secure (HMO)	H8225 - 003	Baker, Clay, Duval, Nassau, St. Johns	Annual Notice of Change H8225 - 003 - English (PDF) Annual Notice of Change H8225 - 003 - Spanish (PDF) - Coming Soon
Ascension Complete Sacred Heart Secure (HMO)	H8225 - 004	Escambia, Santa Rosa, Walton	Annual Notice of Change H8225 - 004 - English (PDF) Annual Notice of Change H8225 - 004 - Spanish (PDF) - Coming Soon

Plan Name	CMS#	County	Annual Notice of Change (ANOC)
Ascension Complete St. Vincent's Access POS (HMO POS)	H8225 - 007	Baker, Clay, Duval, Nassau, St. Johns	Annual Notice of Change H8225 - 007 - English (PDF) Annual Notice of Change H8225 - 007 - Spanish (PDF)- Coming Soon
Ascension Complete Sacred Heart Access POS (HMO-POS)	H8225 - 008	Escambia, Santa Rosa, Walton	Annual Notice of Change H8225 - 008 - English (PDF) Annual Notice of Change H8225 - 008 - Spanish (PDF)- Coming Soon

Plan Benefit Materials | Allwell from Sunshine Health

Plan Materials and Forms

For HMO D-SNP Members:

For HMO D-SNP Members:

For HMO D-SNP Members:

Plan Benefit Materials

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For HMO-POS Members:

Plan Name	CMS#	County	Summary of Benefits
Allwell Dual Medicare (HMO D-SNP)	H5190 - 001	Duval and Volusia counties	Summary of Benefits H5150-001- English (PDF)
Allwell Dual Medicare (HMO D-SNP)	H5190 - 002	Hillsborough, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, and Seminole counties	Summary of Benefits H5190-002 - English (PDF) Summary of Benefits H5190-002 - Spanish (PDF)
Allwell Dual Medicare (HMO D-SNP)	H5190 - 003	Broward	Summary of Benefits H5190-003 - English (PDF) Summary of Benefits H5190-003 - Spanish (PDF)
Allwell Dual Medicare (HMO D-SNP)	H5190 - 004	Miami-Dade	Summary of Benefits H5190-004 - English (PDF) Summary of Benefits H5190-004 - Spanish (PDF)
Allwell Medicare Nurture (HMO D-SNP)	H5190 - 005	Broward, Duval, Hillisborough, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole and Volusia counties	Summary of Benefits H5190-005 - English (PDF) Summary of Benefits H5190-005 - Spanish (PDF)
Allwell Medicare Nurture (HMO D-SNP)	H5190 - 006	Miami-Dade	Summary of Benefits H5190-006 - English (PDF) Summary of Benefits H5190-006 - Spanish (PDF)

Plan Benefit Materials | Allwell from Sunshine Health

Plan Materials and Forms

Summary of Benefits (SB)

For HMO D-SNP Members:

Evidence Of Coverage (EOC)

For HMO D-SNP Members:

Annual Notice of Changes (ANOC)

For HMO D-SNP Members:

Over-The-Counter Benefits

2023 AHIP Flyer

Plan Benefit Materials

Summary of Benefits (SB)

For HMO Members:

For HMO D-SNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D-SNP Members:

Annual Notice of Changes (ANOC)

For HMO Members:

For HMO D-SNP Members:

For HMO-POS Members:

Acupuncture National Coverage

Medicare Prior Authorization List

2023 AHIP Flyer